@layout("/common/_form.html",{js:["/assets/modular/system/btySzgl/btySzgl_add.js"],css:["/assets/expand/module/formSelects/formSelects-v4.css"]}){

<form class="layui-form" id="btySzglForm" lay-filter="btySzglForm">
    <div class="layui-fluid" style="padding-bottom: 75px;">
        <div class="layui-card">
            <div class="layui-card-header">基本信息</div>
            <div class="layui-card-body">
                <div class="layui-form-item layui-row">
                    <input name="" type="hidden"/>

                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label"><span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="id" name="id" placeholder="请输入" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">天财店名<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="tiancai" name="tiancai" placeholder="请输入天财店名" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">饿了么店名<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="elm" name="elm" placeholder="请输入饿了么店名" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">美团店名<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="mt" name="mt" placeholder="请输入美团店名" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">妖码<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="yaoma" name="yaoma" placeholder="请输入妖码" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">营运经理<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="yyjl" name="yyjl" placeholder="请输入营运经理" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">工程店名<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="dm" name="dm" placeholder="请输入工程店名" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">工程地址<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="gcAddress" name="gcAddress" placeholder="请输入工程地址" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">一级区域<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="firstArea" name="firstArea" placeholder="请输入一级区域" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">二级区域<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="secondArea" name="secondArea" placeholder="请输入二级区域" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">食品经营许可证<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="spjyxkz" name="spjyxkz" placeholder="请输入食品经营许可证" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">食品经营许可证截止日期<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="spjyxkzrq" name="spjyxkzrq" placeholder="请输入食品经营许可证截止日期" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">营业执照<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="yyzz" name="yyzz" placeholder="请输入营业执照" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">统一社会信用代码<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="shxydm" name="shxydm" placeholder="请输入统一社会信用代码" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">营业执照地址<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="yyzzdz" name="yyzzdz" placeholder="请输入营业执照地址" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">营业执照名称<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="yyzzmc" name="yyzzmc" placeholder="请输入营业执照名称" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">状态：0->图片为工程同步,1->图片为手动添加<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="sta" name="sta" placeholder="请输入状态：0->图片为工程同步,1->图片为手动添加" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                </div>
            </div>
        </div>
    </div>
    <div class="form-group-bottom text-center">
        <button class="layui-btn" lay-filter="btnSubmit" lay-submit>&emsp;提交&emsp;</button>
        <button type="reset" class="layui-btn layui-btn-primary" ew-event="closeDialog">&emsp;取消&emsp;</button>
    </div>

</form>

@}